GMC guidance - NHS England

Revalidation...
“…should be the
spark that sets alight
the comprehensive
provision of
educational
opportunity and
support for doctors.”
Dr Nick Lyons
Education for Primary Care (2011) 22: 360
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New appraiser training
Welcome back to day two
Facilitators:
Organiser:
Date, Venue:
All images used in this presentation are provided courtesy of the NHS photo library, Microsoft or other free clipart sites.
Housekeeping
3
Ground rules
• Confidentiality
• Listen
• Respect
• Participate
• Punctuality
• Have fun!
4
Looking back to day one
5
Looking ahead to the partial appraisals:
reflection and preparation
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Rehearsing appraisal skills
In your appraisal trios ………..
Time
09:30
Appraiser
C
Doctor
B
Observer
A
10:15
B
A
C
11:00
11:15
Coffee
A
C
B
Finish exercise at 12:00 and go to lunch
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Lunch
8
Conducting an appraisal
Reflection
9
Looking at the personal development plan
(PDP)
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Why bother with a good PDP?
Discuss:
• What makes a good PDP?
• What do you need as an doctor?
• What do you need as an appraiser?
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The PDP – hitting the target
12
What does the PDP look like?
PDPs: all doctors need an agreed PDP
• Links to summary of discussion and is driven by doctor
• Needs ‘SMART’ objectives
• Reflects the doctor’s approach to learning (not the
appraiser’s)
• ‘Quality not quantity’ of entries, as some doctors find
PDPs less useful than others, and learning styles vary
• Not everything needs to go on the PDP – indeed, ‘agreed
actions’ should be captured for each doctor in the summary
• Doctors need to focus on real needs, identified in a
structured and objective way, rather than perceived needs
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SMART(IES) objectives
•
•
•
•
•
•
•
•
S
M
A
R
T
I
E
S
Specific
Measurable
Achievable
Relevant
Timely
Interesting
Economic
Shared success
Making the PDP specific to the doctor
Activist
Experiencing
Pragmatist
Planning & applying
Reviewing
Reflector
Concluding
Theorist
Honey & Mumford, 1992
PDP task
As an individual derive an appropriate PDP objective for
yourself – either from the discussion this morning or as a
new appraiser
Remember:
PDP objectives should be SMART(IES)
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Why bother with a good summary of appraisal?
• For the doctor
• For the appraiser
• For the responsible officer
Discuss:
• What makes a good summary?
• What do you want as a doctor?
• What do you want as an appraiser?
• What should the ‘service’ expect?
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The summary of appraisal
The appraisal summary should cover for each domain:
• an overview of the supporting information and the doctor’s
accompanying commentary
• comment on the extent to which the supporting information
relates to the doctor’s scope and nature of work.
The general summary should include key elements of the wider
appraisal discussion (particularly those arising from the
information shared in section 12 – Achievements, Challenges and
Aspirations) and any actions agreed that have not already been
recorded.
Supporting Information for appraisal and revalidation (GMC, 2011)
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PROGRESS and EXCELLENCE QA tools
Appraiser:
Quality
Assured by:
Date
1
2
3
PROGRESS QA tool
Quality assurance and development of appraisal
documentation
Score (out of
20)
Comments
0-2 (absent – well done)
0-4 (absent – well done)
1
2
How can the appraiser improve the appraisal
documentation?
3
Appraisal identifier (initials)
PROFESSIONAL (2) – is typewritten, objective, free from
bias or prejudice, describes a professional appraisal:
venue, time taken, good information governance, no
identifiable third party info
1
REFLECTS A GOOD APPRAISAL DISCUSSION (4) –
demonstrates support, challenge and focus on the
reflection and needs of the doctor
1
2
3
2
3
OVERVIEW (2) – includes a description of the whole
scope of work and context for the doctor, the
appraisal and the revalidation cycle
1
2
3
GAPS (2) – identifies any gaps in requirements for
revalidation or scope of work and specifies how they
will be addressed (or states if no gaps)
1
2
3
REVIEWS SUPPORTING INFORMATION (SI) AND LESSONS
LEARNED (4) – reviews SI in relation to Good Medical
Practice; comments on SI not supplied electronically
and any information the doctor was asked to bring.
Reflects on lessons learned, changes made and
actions agreed.
1
ENCOURAGES EXCELLENCE (2) – affirms good practice,
celebrates achievements and actions accomplished,
gives examples of good practice and records
aspirations (some of which may have a timescale
over one year)
1
SIGN OFFS & STATEMENTS (2) – ensures the input and
output statements, including health and probity, have
been completed, commented on and, where
appropriate, explanation made to the RO
1
SMART PDP (2) – PDP objectives arise from the SI
and appraisal discussion and are SMART: Specific,
Measurable, Achievable, Relevant and have a
Timescale
1
TOTAL
Overall impression:
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2
3
2
3
2
3
2
3
PROGRESS vs. EXCELLENCE
P
R
O
G
R
Professional
Reflects a good appraisal
Overview
Gaps
Reviews supporting
information and lessons
learned
E Encourages excellence
S Sign Offs & Statements
S SMART PDP
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E Encompasses all
X Excludes bias and prejudice
C Challenge, support and
encourage
E Explain statements
L Look at supporting info and
lessons learned
L Look at last year’s PDP
E Encourage excellence
N Note any gaps
C Contain a SMART PDP
E Explain the new PDP
Summary of appraisal task
• Look at the example summaries and PDPs provided
• Quality assure the write up for Dr No Concerns first, using
the QA tool provided
• Now that you are familiar with the tool, QA the outputs of
Dr Part Time and / or Dr Been Ill
What have you learned?
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There’s no such thing as…
• A perfect summary of discussion
• A perfect PDP
• A perfect appraisal
But…
…we are all striving to improve.
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Tea/coffee
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Preparing for difficult medical appraisals
• Identify potential areas of difficulty within the appraisal
process
• Understand the possible causes for these difficulties
• Develop strategies for dealing with difficult appraisals
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Appraiser concerns
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What doctor problems could make an appraisal
difficult?
• Preparation
• Too much or too little documentation, supporting
information or reflection
• Attitude
• Arrogant/cynical/dependent/disengaged
• Special cases
• Poor performance
• Conduct issues
• Illness
• Whistleblowing
27
Preparation: time to postpone the appraisal?
• Potential conflicts of interest (allocate a different appraiser)
• No pre-appraisal documentation/illegible documentation
• Late receipt of pre-appraisal documentation with no time to
prepare
• No previous summary of appraisal or PDP from last years’
appraisal
• Inadequate supporting information
• Unsuitable venue
• Lack of protected time
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Attitude – don’t take it personally!
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Special cases
Try as far as possible to crystallise:
• Are patients at risk?
• Should the appraisal continue?
• What action are you going to take?
• How you can signpost clearly the next steps to doctor.
Sometimes it is appropriate for the appraisal to continue but
for the appraiser to take action in the way that the appraisal
is written-up or the appraisal statements are signed-off
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Summary –reality is complex
• In practice, doctors do not conform to stereotypes (unless
they are choosing to play a single role).
• Difficult appraisals will usually involve a mixture of some
of these attitudes and behaviours.
• The high flying doctor may also produce too much
meticulously organised paperwork and then reveal that it
is all fuelled by alcohol as a stress reliever.
• Being an appraiser is a privilege but it is not easy and
there are no perfect answers.
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What potential pitfalls do you recognise for
yourself as an appraiser?
The people pleaser
The elder statesman
The head teacher
The rescuer
The perfectionist
The judge
The diffident
The task oriented
The doctor
The money oriented
The over-involved/colluder
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Being self-aware
• Acknowledge that personal stumbling blocks exist
• Do not let them get in the way of delivering an effective
appraisal
• Rehearse alternative strategies within an appraisal
support group or network
• Reflect on and discuss difficult appraisals after they
have occurred (in terms of process, not specific content)
to gain useful insights
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Before each appraisal
Be self-aware
Be doctor aware
What are my personal pitfalls
to beware?
What issues of preparation or
attitude might I have to
challenge here?
If there are no apparent
issues, how can I add value
to this appraisal?
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Handling unexpected serious concerns arising
during the appraisal discussion
Discussion:
• The requirement to suspend an appraisal discussion because
of a serious concern is not new
• It is exceptionally rare for such a serious concern to arise
during the appraisal discussion that the appraiser needs to take
off the ‘appraiser hat’ and move into other processes.
Exercise:
• A chance to try out different ways of reacting to a doctor who
reveals something for the first time during appraisal that raises
serious concerns about their conduct, capability, or health.
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Local processes and specialty specific issues
•
•
•
•
•
•
•
Appraisal leadership and support
Appraisal policy
Occupational health and poor performance procedures
Whistle-blowing policies
What does your designated body advise?
What does your royal college or faculty advise?
Are you clear about how this links to the GMC
requirements for revalidation?
• Any other issues?
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Questions and answers
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Evaluation forms
• We welcome all constructive feedback.
• If anything is unclear and you wish us to get back to you,
please put your name and contact details on the form.
• Remember that you need to look again at the self
assessment of competencies and mark whether your
confidence has changed as a result of the training today.
• Thank you for your participation.
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Delivering a supportive and challenging medical
appraisal is worth the effort
Thank you for your hard work
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